title: Thrombolysis for acute stroke in hemodialysis: international survey of expert opinion.
abstract: OBJECTIVE
  Although data are absent, it has been stated that thrombolysis is probably not safe in the treatment of acute stroke in patients undergoing hemodialysis. The objective of this study was for stroke experts to define the range of management concerning thrombolytic treatment of acute stroke in hemodialysis.
  
  
  METHODS
  Sixty-five stroke experts in thrombolytic therapy of acute ischemic stroke were queried regarding their personal experience in the use of thrombolysis in hemodialysis patients. Hypothetical case scenarios were presented.
  
  
  RESULTS
  Of the 65 stroke experts who were queried, 40 (62%) responded. One-third of the responders had previously treated hemodialysis patients with recombinant tissue-type plasminogen activator (rt-PA). Most favored use of intravenous rt-PA for hemodialysis patients with acute ischemic stroke. When presented with a case of a patient who had recently undergone dialysis with a mildly prolonged activated partial thromboplastin time (aPTT), 50% favored immediate intravenous thrombolysis. Seventy-eight percent of the experts would have considered an intra-arterial approach and would have preferred mechanical clot retrieval to thrombolysis.
  
  
  CONCLUSIONS
  Despite the acknowledged absence of data and prevalent concerns about bleeding risk, most surveyed experts favored its use. One-third reported treating hemodialysis patients with this therapy. Although these results do not substitute for data, they usefully define the range of current practice of stroke experts.
authors.affiliation: Department of Neurology, University of Texas Health Science Center, 8300 Floyd Curl Drive MC# 7883, San Antonio, TX 78229-3900, USA. palacios0@uthscsa.edu
authors.forename: Santiago
authors.initials: S
authors.lastname: Palacio
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Gonzales
authors.forename: Navdeep S
authors.initials: NS
authors.lastname: Sangha
authors.forename: Lee A
authors.initials: LA
authors.lastname: Birnbaum
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy; D019538:Health Care Surveys; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D009398:Nephrology / Q000379:methods*; D010314:Partial Thromboplastin Time; D010960:Plasminogen Activators / Q000008:administration & dosage; D006435:Renal Dialysis; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D010960:Plasminogen Activators